need help with pm doctor-Shoreline

Dave- I was wondering if you could help. I've read a lot of your posts and you always seem to have sound advice. I've made several other posts and my biggest problem is I can't get my pm doctor to change me from 60 percs a month to a long acting pain medicine. It aggravates me because I see so many people out there who have no problems getting this yet I have yet to be able to give it a try. I've had three surgeries, one in 1999, one in 2001,one in2003. Work comp has declared me perm disabled because of scar tissue nerve dammage and failed back syndrome. I've tried to get work comp to approve 2nd pm doctors oppinion but no luck so far. This one pm doctor does not want me to even try long acting opiods because he says that he is affraid that I will still need bt meds and he is affraid that my tolerances will increase if I go this route. How do I reply to that? I'm in so much pain that I can't even function. Can't sleep well. I'm just so tired of hearing you'll have to learn to live with the pain. I don't know what else to do I've tried everything else and percocette has been the only thing to give me any relief at all. I only wish I could convince the doctor to let me try it and decide for myself. The percs only give a few hours of relief each dose and I need something more.

Hey EJ, I didn't get a chance to see if you responded to my questions about the doc your seeing. Mainly, does he use longer acting or stronger meds on any of his patients. If he doesn't , I honestly doubt you going to be his exception, regardless of what's wrong, what's documented, and even the obvious like dangerously huigh BP and lulse from pain. If he doesn't believe in the benefit of opiates, he's simply not going to go there and change his belief system after years of med school and practice. Docs either believe people can benefit and those benifits outweigh the negative side effects and the risks of abuse or they were tought all through their school and practice prior tothe ivetion of Oxycontin that opiates aren't the way to manage chronic pain.

You absolutely have the right to see what another PM doc has to offer. Maybe being more specific may help in the process, Asking for something he simply can't do or doesn't offer. Does he manage pumps or SCS. If not, than you have the right to talk to someone that's qualified and certied to implant and manage these devices. If you specifically ask for a doc to mamane a pump, you pretty much know the doc believes in the use of opiates in some way. I have read articles from PM docs that will only dispense opiates through a pump as so little needs to be used and the patient can't abuse it. The ddoc has complete control, but that doc was a nut job IMO. What's the point of implanting a pump if you not shooting for max benefit even though max benefit is usally believed to be 50% relief.

If you don;''t know who to ask for, you can contact medtronics and they will giuve you a list of docs certidin your area that are cerified to implant and manage the pumps by medtronics themself. I'm sure some docs are doing pumps that aren't on medtronics list or docs that use the other pump "Codman by J&J" may have a cert process and give you a list of their docs, starting with a doc you know has some belief in the use of opiates will hopefully get you pointed in the right direction.

The point is to simply find a doc that believes you can benefit from opiates. Even if you're nowhere near ready for a pump, a PM doc that does pump management will see it's premature to consider if you haven't given orals a try. Hopefully the doc will take you on a go through the process of trail and error with oral meds and if you reach a point where orals can't help without intolerable side efefcts, at least you know you have a doc that is capable of taking the next step . Most likely a pump doc is going to be an anesthesiologist that's part of a larger practice, There may be other procedures you can try, but you're right, benfits for life don't mean squat if they aren't doing anything to improve the quality of your life.

There is also a complaint process for the insurance industry and likely an ambudsman to contact to hear your complant. Lawyers really aren't getting paid for a life long fight over medical beni's so you may not get the help you think your attorney that helped with the settlement should provide, but there is the Industrial commision to contact and your states version of the an Insurance comiision. When dealing with the state, there isn't usually aquick fix, corrospondance is done by mail and you simply have to wait for them to respond. That's why the sooner you work on something you can acomplish the better.

I really don't think your can change the POV of a doc that's been in practice for years and made up his mind about opiates long before he met you or anyone in your condition. I've met plenty of PM docs that try to sell their own BS POV that all pain can be managed with hypnosis or the right anti D and relaxation technique. I would love to see them try to sell that load on a cancer ward and see how well it goes over with the family of people watching their loved ones suffer.

If your married, perhaps involving your spouse, My wife went with me to my first apt with my present PM doc and basically said "do something or I'm, leaving him with you." I think he got the idea of how unpleaseant living with someone that's bed riddden with intractable pain can be. The right meds can mean the difference between no quality of life and being able to particapte in life someway. Whether it's simply taking care of your own needs or contributing to the household in some way as far as cleaning, cooking, shopping etc. It's not to much to ask to be able to get through a load of dishes or laundry or a trip to the grocery store. Yes it's tough, but it gets easier the more you do it. Pain relief allows you to be more active which rebuilds lost strength and restores some degree of self esteem. There are too many potential positive efects not to give it a try when all esle has failed. Like every surgery, months or years of PT, Injections, antiD's, etc etc.

With comp you do everything that's asked of you or they cut beni's, So I would guess you have jumped through every hoop placed before you. It sounds like your at a point where you either find a doc that's willing to work with you, or you start asking for comp to pay for home health care aid to take care of your basic needs since they won't let you find a doc to help you work towards a higher level of function. Comp might be a little more flexable when given that choice.

Sorry EJ, It's just been my experience that the decsion to use opiates on a pateint has been made long before you ever meet the doc. He either does believe in their benefit or he doesn't.

Thanks dave,
You take a lot of your time to write and help people out the best that you can. For that I am thankful. Yes I was wondering the same thing about my doctor that you had mentioned and I actually asked him. I wanted to know who I was dealing with so I said " Do you ever prescribe long acting pain meds for anyone?". His response was that he would prescribe it for some one who had a fracture. This is bs because I don't know if he understands how much pain I am in. I guess I'll have to keep trying to get work comp to approve another opinion. I've tried and they actually know that I am trying to find another doc who is willing to prescribe long acting opiates. I think that they are denying because they're trying to save a few bucks. Different meds would be more expensive and it is not something I could afford on my own even if I found a doc outside of the work comp loop that is willing to help. The pm doc I am seeing now even contacted work comp on my behalf for me to get a 2nd opinion. My lawyer has wrote them a letter and I still have had no luck getting them to approve. Work comp really stinks and is a inhumane form of medical treatment. They just wear you out till you can't take any more.